Madison/Preparatory High School Transportation Request Form
If you would like your son/daughter to be assigned to a bus route, please complete and submit this form NO LATER than January 15th, 2021.

Please submit a separate form for each student in your household who will ride the bus to Madison/Prep High School.

All students must have and wear a mask, covering their mouth and nose, in order to board the bus.

If you have any questions, please contact Tim Pace, Director of Transportation, at tim.pace@madisondistrict.org or by phone at 248-399-7800 ext. 3411
Email address *
Student Last Name *
Student First Name *
Parent Last Name *
Parent First Name *
Address *
Street Number, Street Name, City, Zip Code
Phone Number *
I understand and agree that my child must wear a mask in order to ride district transportation. *
Required
Screening for symptoms:
Are you currently experiencing ONE or more of the following symptoms unrelated to a known pre-existing condition (e.g. asthma, allergies)?

New cough
Shortness of breath
Difficulty breathing
New loss of taste or smell
No, I am not experiencing one or more of the above symptoms.

If you are experiencing one or more of the above symptoms, stay home, consult your medical provider, and get tested for COVID-19.


Are you currently experiencing any TWO of the following symptoms unrelated to a known pre-existing condition (e.g. asthma, allergies)?

Fever (100.4 degrees or greater)
Chills (rigors)
Diarrhea (2x in 24 hours)
Congestion or runny nose
Nausea or vomiting (2x in 24 hours)
Headache Muscle aches (myalgias)
Sore throat
Fatigue
No I am not experiencing two or more of the above symptoms.

If you are experiencing two or more of the above symptoms, stay home, consult your medical provider, and get tested for COVID-19.

If experiencing only one of these symptoms, stay home and consult your medical provider. You may return to work/school after being fever free for 24 hours without taking fever reducing medication and symptoms have improved.
I agree to screen my child each morning for signs and symptoms of Covid-19 according to the Oakland County Health Department guidelines prior to boarding the bus.
Students displaying symptoms of Covid-19 must not be sent to school on the bus.
A copy of your responses will be emailed to the address you provided.
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